Please complete the following application to request financial assistance for your clients needs. This application should be filled out by individuals representing a community organization that serves individuals participating in a substance use treatment, recovery, or a re-entry program.

Please indicate the specific needs for which you are seeking funding by inputting the amount in the appropriate box.

I hereby certify that the information provided in this application is accurate and complete to the best of my knowledge. I understand that the approval of funds is subject to the discretion of Unwritten.org, and I agree to comply with any reporting or accountability requirements set forth by Unwritten.org if my application is approved.

I acknowledge and abide by HIPPA and will keep client information confidential.